A 20-year-old gravida 1 at 32 weeks presents for her routine OB visit. She has no medical problems. She is noted to have a blood pressure of 150/96, and her urine dip shows 1+ protein. She complains of a constant headache and vision changes that are not relieved with rest or a pain reliever. The patient is sent to the hospital for further management. At the hospital her blood pressure is 158/98 and she is noted to have tonic-clonic seizure. Which of the following is indicated in the management of this patient?
a. Low-dose aspirin
b. Dilantin (phenytoin)
c. Antihypertensive therapy
d. Magnesium sulfate
e. Cesarean delivery
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care. Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.
The correct answer is d; Magnesium sulfate.
This patient has eclampsia. She requires delivery. Magnesium sulfate is given for seizure prophylaxis. Antihypertensive therapy is usually initiated for systolic blood pressure >160 or diastolic blood pressure >110.
Preeclampsia is a syndrome of hypertension and proteinuria that can be associated with other signs and symptoms, such as visual disturbances, headaches, epigastric pain, and laboratory abnormalities ,such as hemolysis, elevated liver enzyme, and low platelets (HELLP syndrome). Criteria for the diagnosis of preeclampsia include blood pressure of 140 mmHg systolic or higher or 90 mmHg or higher that occurs after 20 weeks of gestation in a woman with previously normal blood pressure. Proteinuria is defined as urinary excretion of 300 mg or higher on a 24-h urine specimen.
The diagnosis of severe preeclampsia is made if one or more of the following criteria is present: blood pressure 160 mmHg systolic or higher or 110 mmHg diastolic or higher, proteinuria of 5 g or more on a 24-h urine collection or 3+ or greater on random urine samples, oliguria of less than 500 mL in 24 h, cerebral or visual disturbances, pulmonary edema or cyanosis, epigastric or right upper quadrant pain, impaired liver function, thrombocytopenia, or fetal growth restriction.
The incidence of preeclampsia is 5% – to – 8% and primarily occurs in first pregnancies. Risk factors include chronic hypertension, pregestational diabetes, multifetal gestations, vascular and connective tissue disease, nephropathy, antiphospholipid syndrome, obesity, older age, and African American race.
Eclampsia is the presence of new-onset grand mal seizures in a woman with preeclampsia. Women with eclampsia should be stabilized quickly; magnesium sulfate should be started to prevent further seizures; and antihypertensives should be used to control blood pressure. The patient should be delivered in a timely fashion, and the method of delivery should depend on factors such as gestational age, fetal presentation, and cervical exam. Cesarean delivery is not always necessary.
Magnesium sulfate has been shown in randomized control trials to be better than phenytoin or diazepam at preventing seizures.
Low-dose aspirin and calcium supplementation have not been shown to be beneficial in preventing preeclampsia.